ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Locally Delivered Anti-Microbials Combined with Scaling and Root Planning Improves the Management of Chronic Periodontal Disease Compared to Scaling and Root Planing Alone
Clinical Question Is it more effective to use locally delivered anti-microbials with Scaling and Root Planning compared to Scaling and Root Planning alone in managing Chronic Periodontitis?
Clinical Bottom Line The present meta-analysis study suggests that the use of locally delivered anti-microbials at the same time with Scaling and Root Planning is more effective than Scaling and Root Planning alone. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22368351Kalsi/20114 studies involve 80 ptsMeta-Analysis
Key resultsThis meta-analysis of four studies was comparing the significance of Local drug delivery with SRP compared to SRP alone. The total population of 80 with 97 controls sites and 111 tests sites. These studies had measured the outcome on probing depth, bleeding index and plaque index for both the test and control groups. In the test group, SRP was done with local drug delivery, whereas, in the control group only SRP was done alone. It has found a significant reduction in the bleeding on probing (mean+ SD= 0.72 + 0.27) and plaque scores (mean+ SD= 1.06 + 0.54) in SRP alone. With SRP and local drug delivery, it was found that a significant reduction in the bleeding on probing (mean+ SD= 0.92 + 0.3) and plaque scores (mean+ SD= 1.16 + 0.57). Overall, a value of (1.9) shows that a large effect of performing SRP + local drug delivery in the reduction of probing depth and bleeding on probing measures. The antibiotics used in this meta-analysis of four studies were : 10% Doxycycline Hycylate (ATRIDOX), Minocycline Hydrochloride (ARESTIN), Tetracycline Hydrochloride (Periodontal plus AB), and Chlorhexidine Gluconate (Periochip). When comparing between these drugs, it was found a significant reduction in probing depth (PD) when using CHX chip. Regarding bleeding on probing (BOP), it was found a significant benefit with 2% Mioncycline when combined with SRP and no benefits were found with ATRIDOX and TET fibers. Although the plaque index (PI) was found to be reduced in all groups, a statistically significant benefit was found with Periodontal plus AB and Periochip.
Evidence Search The following search strategy used in PubMed: Local[Title] AND Drug[Title] AND Delivery[Title] AND Scaling[Title] AND Root[Title] AND Planing[Title]
Comments on
The Evidence
The study represented the full spectrum of patients who had moderate to advanced periodontal disease. The criteria for the findings were explicit and credible. The diagnostic work-up was comprehensive and consistently applied. Even though a follow-up study was not done, the author suggests future research. The author’s position in the Department of Periodontics, College of Dental Sciences, Davangere, Karnataka, India did not indicate competing interest.
Applicability The patients cited in this study were representative of periodontal patients. The treatment of SRP in combination with locally delivered anti-microbials is feasible in the dental operatory. It appears obvious that the combined technique as compared to SRP alone would save the patients both time and money as well as being a more effective modality.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (General Dentistry) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Local Drug Delivery, Scaling Root Planning.
ID# 2511
Date of submission: 07/22/2013spacer
E-mail Saffa.alani@ucdenver.edu
Author Saffa Alani
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ronald N. Brown, DDS
Faculty mentor/Co-author e-mail Ronald.Brown@ucdenver.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Sherry Cline, RDH (Phoenix, AZ) on 03/06/2014
I am a bit confused, is the periodontal plus AB beneficial or insignificant when doing SRP?
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